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There are various myths which have been incorporated in the chronic pain patients' mind through various media, relatives etc. They not only make them suffer but also play an important role in changing their psychology towards certain pain treatment modalities. This article has been written in order to throw some lights on those myths of pain management and what actually are the facts behind that.
1)MYTH: NSAIDs (Non-Steroidal Anti-inflammatory drugs) are the drug of choice for pain relief.
FACT: Many a times NSAIDS (like Ibuprofen, Diclofenac etc) are prescribed for all kinds of pain, as they are the most commonly prescribed over the counter drugs. But before taking these we should have knowledge about the type of pain and character of pain. NSAIDs should be prescribed for relief of nociceptive type of pain, specially when there is an inflammatory component. Most of the time in chronic pain, sensitization develops and NSAIDs have a limited role. More ever NSAIDs should not be taken for long time, because of their side effects. Paracetamol, opiods and co-analgesics like antidepressant and anticonvulsants have got a better role to play.
2)MYTH: If a patient is on opioid for a long time, addiction follows successively.
Fact: Addiction characterized by compulsive drug seeking and use, despite of harmful consequences. However dependence is characterized by the need of a drug by the person to function normally and abruptly stopping the drug leads to withdrawal symptoms. Opoids forms a part of treatment for chronic pain. If is its prescribed for a short duration the risk of development of addiction is minimal. Also in some opioids like tramadol, fentanyl etc. addiction is very rare.
3) MYTH: Bed rest for 3 to 4 weeks is the best and easiest treatment for acute back pain.
FACT: When stability of spine is at risk, and in presence of other red flags, bed rest is advisable. In all other situations more than 2-3 days bed rest is not advisable. Bed rest reduces muscle mass, increases osteoporosis, enhances disc degeneration, increases chance of other complications like hypostatic pneumonia, deep vein thrombosis etc. Thus within the limitations of pain, patients should be allowed to do his/her daily life activities.
4) MYTH: When we are not able to diagnose the cause of pain by different modern imaging, it must be psychological.
FACT: Image can show us the structural abnormalities. But some structural abnormalities may not produce pain and in some kinds of pain no structural abnormalities are observed. WHO states that pain more than three months is a disease itself and must be treated. Pain if presents for a longer time affective components manifest in the form of the anxiety, depression, sadness, mood disorder, disturbed sleep, irritability, decreased concentration, loss of appetite etc. We should be specially trained to distinguish between the two things: chronic pain as manifestation of depression or depression a manifestation of chronic pain. Certain conditions like fibromyalgia where there is no manifestation of chronic pain to be diagnosed clinically but still the disease exist
5)MYTH: Pain medications should be taken only when pain is severe and unbearable.
FACT: We should start taking the pain medicine even when pain is mild should not wait it to become moderate to severe. This is to maintain a constant concentration of drug in our body to break the pain cycle and to prevent the development of sensitization. Some pain medications like co-analgesic Duloxetine are slow and effective only after 1-2 weeks.
6)MYTH: Investigations like X-rays, MRI are mandatory to diagnose chronic pain
FACT: After ruling out red flags where an extensive investigations and immediate treatment is required, in most of the chronic pain patients a detailed history with a relevant clinical examination is all that is required to arrive to a clinical diagnosis. For example in case of facet joint and sacroiliac joint arthropathy a diagnostic block with a local anaesthetic is required to diagnose them as a source of pain generators rather than the costly investigations like MRI or CT scan. Investigations should be there to support our clinical diagnosis, we should not be treating the reports rather we should trained ourselves to treat the symptoms. For example an asymptomatic disc prolapse patient need not to be treated if patient does not have any symptom of that.